Tim Harrison, a registered nurse from Massachusetts, has worked with MSF in South Sudan on several occasions, most recently in Malakal, from which the team had to be evacuated due to extreme violence in the area.

“It was a remarkable experience and then ultimately it was one of the most disappointing experiences because of the way that we lost the ability to control the space,” Harrison says. He was part of a small team initially sent to treat kala azar. “There were five of us to start with, three medics, the project coordinator, and a logistician.” Then fighting came to Malakal, and wounded patients and others started arriving at the hospital. “Ultimately, the hospital became an IDP camp,” he says, but as the days passed, the chaos of the moment overwhelmed any sense of sanctity the hospital once enjoyed. “We couldn’t control weapons in and out of the hospital,” he recalls. They had a checkpoint for weapons at the hospital gate, but “there were 50 other ways to get in.”

Civilians and staff would report what they’d seen. “The stories were just devastating,” Harrison says. “Door-to-door fighting. I remember a very skilled clinical officer we worked with closely came in, and he’s in his 50s, a fellow who’s lived his whole life in South Sudan. He said he’d never seen anything like it. And this is a country that had 35 years of civil war. He was clearly traumatized. Eventually he moved into the hospital because he couldn’t stay at home any more. He brought his family.”

The violence would not abate, however. “We simply had no more room to be able to function, and our own safety, and the safety of everybody in that hospital, was at risk. The team sat down on a Sunday and, as we did constantly, went through the risk and the benefit of our being there. Can we do the job? Are the people going to benefit? Can we continue to work? We decided we would stay. But by Wednesday, everything had changed. The hospital was just a tinderbox; any one small event would just set off the entire place. Everybody was living there, IDPs, cows, goats, soldiers. There was alcohol all over the place.”

A drunk soldier shooting his gun into the air confirmed what they knew. “There’s nobody in control of this militia now, nobody that you can call and say, ‘Your guy just shot up our compound, you better do something about it,’ because there’s just nobody in charge… Michael, the PC, had a conversation with the opposition force leader, and he said that he thought it was a really good idea that we leave. He was acknowledging that there was no way to control what was going on.”

The decision was crushing, the logistics daunting. The airport was closed. The town was on a river and there was no way to just drive away. “We ultimately went to the UN compound. That really felt—first of all, it’s a defeat that you have to seek safe haven. What does this look like to the community, that MSF… we’re not running away, but you are, I think, acknowledging that the chaos is not something that you can continue working in.” What’s more, he adds, it meant, and still means, acknowledging that much of their mission went unfinished and, worse, that many people, including medical staff and patients, could not leave. They had to stay behind and endure whatever came next.